Skip to main content
Corporate

Interactive Medicare Electronic Remittance Advice (ERA)

The Medicare Electronic Remittance Advice (ERA) is a notice sent to home health and hospice providers explaining how billing transactions are processed (paid, rejected, or denied). Billing transactions include final claims, adjustments, and canceled, denied, or rejected claims, as well as Requests for Anticipated Payments (RAPs). Medicare provides the PC-Print software for provider to view and print the ERA. Other software is available; however, the following information represents the view of the ERA using the PC-Print software. Providers are also able to view and print Medicare remittances using myCGS (the CGS Web portal). The following additional resources are available on the Centers for Medicare & Medicare Services (CMS) website.

This interactive guide provides an overview of the ERA using PC-Print. Select the screen option (below) that you wish to view. As you move your mouse over the area of interest, the field(s) will highlight. Click on the area of interest to view more detailed information.

PC-Print offers four different options to display and print data.

  • All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.
  • Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.
  • Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY13 and FY14, two separate bill type summary screens will be provided. One screen will display the FY13 claims and the other will display a summary of the FY14 claims.
  • Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustment information, only if financial adjustments are made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article. For a complete list of Provider Level Adjustment Reason Codes, refer to the ASC X12N 835 Implementation Guide: Health Care Claim Payment/Advice available on the Washington Publishing CompanyExternal Website website.

All Claims (AC) Screen

The All Claims (AC) screen provides information for multiple billing transactions at once. The AC screen will list billing transactions in alphabetical order by the beneficiary's last name.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field will display. Click on the fieldto view more detailed information.

PATIENT NAME PATIENT CNTRL NUMBER FRM DT COST REPTD CHGS SN DAYS MS DAYS REIMB RATE ALLOW/REIM INTEREST
ICN NUMBER HIC NUMBER THR DT COVDV NCVD/DENIED PT DAYS NA DAYS MSP PRI PAY PROC CD AMT PAT REFUND
CLAIM # CLM STATUS MEDICAL REC NUMBER NCVDV CLAIM ADJS ST DAYS COINS AMT PROF COMP LINE ADJ AMT DEDUCTIBLES
NATIONAL PROVIDER ID HIC CHG=X TOB=XXX CV LN NCV L COVD CHGS OT DAYS ESRD AMT CONT ADJ AMT NET. REIMB

Single Claim (SC) Screen

The Single Claim (SC) screen provides a detailed summary of a single billing transaction. An SC screen is available for each billing transaction listed on the AC screen.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field will display. Click on the fieldto view more detailed information.

FPE
PAID
CLM#
NPI TOB
PATIENT PCN
HIC SVC FROM MRN
CLAIM STAT THRU ICN
REIM RATE COINSURANCE
REPORTED HHA SN AMT MSP PRIM PAYER
NCVD/DENIED HHA PT AMT CASH DEDUCT
CLAIM ADJS HHA ST AMT PAT REFUND
LINE ADJ AMT
COVERED HHA OT AMT PROC CD AMOUNT
HHA MS AMT ALLOW/REIM
COST REPT HHA NA AMT
COVD/UTIL HSP ROUT CARE INTEREST
NON-COVERED HSP CONT CARE CONTRACT ADJ
COVD VISITS HSP GENERAL
NCOV VISITS HSP RESPITE NET REIM AMT
HSP PHYS SVC
HSP OTH
REMARK CODES
REV DATE HCPCS APC/HIPPS MODS QTY CHARGES ALLOW/REIM GC RSN AMOUNT REMARK CODES
LICN HCPI
SVC Desc

Bill Type Summary (BS) Screen

The Bill Type Summary (BS) screen provides a summary of billing transactions for each type of bill and for each fiscal year (FY) based on the billing transactions included in the ERA. For example, if there are home health claims processed with the type of bill 33X for FY13 and FY14, two separate bill type summary screens will be provided. One screen will display the FY13 claims and the other will display a summary of the FY14 claims.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field will display. Click on the fieldto view more detailed information.

FPE
PAID
CLM#
NPI TOB
REIM RATE
REPORTED DRG AMOUNT MSP PRIM PAYER
NCVD/DENIED DRG/OPER/CAP PROF COMPONENT
CLAIM ADJS LINE ADJ
COVERED OUTLIER PROC CD AMOUNT
CAP OUTLIER
COST REPT CASH DEDUCT
COVD/UTIL BLOOD DEDUCT INTEREST
NON-COVERED COINSURANCE CONTRACT ADJ
COVD VISITS PAT REFUND PER DIEM AMT
NCOV VISITS NET REIM AMT

Provider Payment Summary (PS) Screen

The Provider Payment Summary (PS) screen provides a summary of the payments made to billing transactions included in the ERA. In addition, this screen will show financial adjustments information, only if financial adjustments have been made. For additional information, refer to the "Remittance Advice (RA)/Electronic Remittance Advice (ERA) Payment Summary Page and Forward Balances (FB)" article.

As you move your mouse over the area of interest, the field(s) will highlight and the name of the field will display. Click on the fieldto view more detailed information.

NPI
CHECK / EFT NUMBER
PAYMENT TOTAL BILLING CYCLE
TOTAL CLAIMS TOTAL PIP CLAIMS
FINANCIAL ADJUSTMENTS
Telephone, Facsimile, Electronic Mail, Uniform Resource Locator (URL), Payer Web Site Uniform Resource Locator (URL)

Updated: 02.26.18


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved